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Epidurals Don't Cause
Long-Term Back Pain

Excerpt By Kathleen Doheny, HealthScoutNews

(HealthScoutNews) -- Epidurals, used for pain relief during labor, don't seem to cause the back problems later on that many women fear.

British researchers have found no significant differences in self-reported low back pain or disability in women who received epidurals and those who got other kinds of labor pain relief. The report appears in tomorrow's issue of the British Medical Journal.

The researchers assigned 369 first-time mothers-to-be either to a group that received an epidural for pain relief or to a group that got various other forms of pain relief. An epidural is a local anesthetic, delivered in the small of the back, just outside the spinal canal. It lets a woman remain conscious during childbirth.

Then, they asked the women to participate in a follow-up study to track back pain and other problems; 151 from the epidural group and 155 from the non-epidural group participated. The researchers say they were prompted to do the study because several studies on back pain and epidurals have produced inconsistent results.

"We found no real surprises, and the study merely confirmed what we already suspected: that there was no causal association between epidurals for labor and long-term backache," says lead author Dr. Charlotte Howell, a consultant anesthetist at the North Staffordshire Hospital Trust, in Stoke on Trent, Staffordshire.

"But it was interesting to see how similar the groups were in terms of the results," Howell adds.

Back pain, however, was common in both groups. More women in the epidural group reported severe pain, the researchers found. However, pain lasting more than a year was more common among the women who did not receive an epidural, with 64 women in the non-epidural group having pain for more than a year and 47 of those in the epidural group having pain that long.

"It is highly likely that long-term backache following pregnancy is due to the pregnancy itself," Howell says. "But this is difficult to establish because many women have back pain and many women also use epidurals. They tend to associate the two, and this will probably continue to be the case."

Women wondering what pain relief is best for them during labor should consult their anesthesiologist. "There is rarely a good reason to advise a woman against an epidural for labor, and no evidence to suggest that epidurals make established back pain worse," Howell adds.

Anesthesia experts have mostly praise for the study.

"This is an obvious finding for those of us who practice in this arena," says Christopher Stein, president of the California Association of Nurse Anesthetists who works in pain management and has experience in obstetrical pain relief.

Still, he says the study may help dispel misconceptions about epidurals that persist among some women, who may avoid them due to what they mistakenly think is a higher risk for lower back pain.

"The study has a good random sample," Stein adds.

However, he does see a few flaws. "They didn't control for who was doing the epidural," he says, although he concedes that would be difficult to do. Still, the skill of the operator, he adds, can make a difference. Also, they didn't ask about preexisting back pain.

"Epidurals are very safe," adds Dr. Michael Ferrante, an anesthesiologist at Santa Monica-UCLA Medical Center and co-director of the UCLA Spine Center. "There is no trauma, except to the soft tissue and that heals within two weeks or so."

He often hears concerns about epidurals raising the risk of low back pain, but tells patients it is "pure superstition."

The latest study, he says, "is nice, though a little bit flawed." He, like Stein, points out the researchers did not control for preexisting back pain.

What To Do

For information on different forms of pain relief during childbirth, see The American Association of Nurse Anesthetists or the American Society of Anesthesiologists.

Reference Source 89


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